GPs' perspectives on diagnostic testing in children with persistent non-specific symptoms: a qualitative study
Lianne Jw Mulder1, Sophie M Ansems1, Marjolein Y Berger1
1Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, the Netherlands.
Insights
General practitioners (GPs) consider factors beyond diagnosis when deciding on diagnostic tests for children with persistent non-specific symptoms (PNS). Their decisions are influenced by medical, psychosocial, and resource considerations, differing from adult patient care.
Area of Science:
- Pediatric healthcare
- General practice
- Diagnostic decision-making
Background:
- Diagnostic testing is common for children with persistent non-specific symptoms (PNS).
- Both under- and over-testing have negative consequences.
- GP perspectives on testing in children with PNS are under-researched.
Purpose of the Study:
- To explore General Practitioners' (GPs) views on diagnostic testing decisions in children with PNS.
- To compare these perspectives with GPs' motives for testing adults.
Main Methods:
- Qualitative study using semi-structured interviews with Dutch GPs.
- Thematic content analysis of transcribed interviews exploring real-life cases.
- Purposive sampling until data saturation.
Main Results:
- Twelve GPs participated, revealing decision-making influenced by medical, psychosocial, consultation management, and resource utilization factors.
- GPs were more hesitant to test children due to vulnerability, lower organic disease probability, and reduced autonomy.
- Motivations for testing extended beyond diagnostic uncertainty, similar to adult care.
Conclusions:
- GPs' diagnostic testing decisions in children with PNS are complex and multifactorial.
- Interventions and guidelines should address these broader influencing factors.
- Understanding these perspectives can inform strategies to optimize testing practices.
Background:
Diagnostic testing is prevalent among children with persistent non-specific symptoms (PNS), and both undertesting and overtesting have negative consequences for child and society. Research in adults with PNS has shown that GPs use diagnostic testing for reasons other than diagnosis, but comparable research has not, to the best of our knowledge, been conducted in children. Understanding GPs' perspectives of testing decisions in children could provide insights into mechanisms of undertesting and overtesting.
Aim:
To investigate GPs' perspectives of conducting or refraining from diagnostic testing in children with PNS and the differences compared with their motives when treating adults.
Design And Setting:
Qualitative study using semi-structured interviews with Dutch GPs.
Method:
We purposively sampled GPs until data saturation. Reasons for conducting or refraining from diagnostic tests were explored using two real-life cases from daily practice. Online video interviews were transcribed verbatim. Data were collected and analysed concurrently by thematic content analysis.
Results:
Twelve GPs participated. Their decision making involved a complex trade-off among four themes: medical considerations (for example, alarm symptoms), psychosocial factors (for example, doctor-patient relationship), consultation management (for example, 'quick fix'), and efficient resource utilisation (for example, sustainability). Compared with when treating adults, GPs were more hesitant to conduct diagnostic testing in children because of their higher vulnerability to fearing invasive procedures, lower probability of organic disease, and reduced autonomy.
Conclusion:
As in adults, GPs' decisions to conduct diagnostic tests in children were motivated by reasons beyond diagnostic uncertainty. Educational programmes, interventions, and guidelines that aim to change the testing behaviours of GPs in children with PNS should target these reasons.
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